Nadir Weight Research Articles

Adding Evidence to an Evidence-Based Classification for Recurrent Weight Gain after Bariatric and Metabolic Surgery from a Norwegian National Registry.

In 2023, the first evidence-based classification for recurrent weight gain (RWG) after metabolic and bariatric surgery was introduced. It uses early and late follow-up weight loss benchmarks based on standard deviations (SD) of percentage total weight loss(%TWL) results from the large Dutch Audit for Treatment of Obesity (DATO) registry (n > 18,000). We aimed to validate this classification and confirm its clinical relevance with an external cohort. The DATO-based classification defines all RWG as grade 1, as long as weight-loss does not drop below DATO's late-follow-up minus one SD benchmark (20%TWL). Grade 3 represents clear outliers whose RWG evolves below DATO's late follow-up minus two SD benchmark (10%TWL), with grade 2 in-between. Grades 2a/3a represent initial suboptimal clinical response, with nadir %TWL never exceeding DATO's early-follow-up minus one SD benchmark (25%TWL). Grades 2b/3b represent late clinical deterioration from nadir weight loss ≥ 25%TWL. We compared baseline characteristics, SD based benchmarks, RWG and comorbidities from the Scandinavian Obesity Surgery Registry Norway (SOReg-N) with these DATO-derived grades. The SOReg-N population (n = 3064) was comparable at baseline, with more sleeve gastrectomies (54% versus DATO 22.5%). The SD benchmarks were at early follow-up minus one SD 25.8%TWL, at 5years minus one SD/minus two-SD 17.2%TWL/7.0%TWL (DATO 25%TWL/20%TWL/10%TWL). Percentage of patients and amount of RWG were similar to DATO. In line with DATO, comorbidities were predominant in grades 2a/3a, with least improvement in grade 3a. Also, grade 3b showed more favorable characteristics at baseline. The SOReg-N cohort confirmed the weight-loss benchmarks defining the DATO-derived grades, the distribution of patients and their RWG across the grades, and correlations between grades and comorbidities. Male gender, older age and comorbidities were predominant among patients with initial suboptimal clinical response (RWG grades 2a/3a), but not for late clinical deterioration (RWG grades 2b/3b). This classification can be used for populations with diverse weight loss trajectories and offers an evidence-based guide for clinical decision-making and standardization.

A randomized, double-blind, placebo-controlled trial of weight loss using liraglutide 3.0 mg for weight recurrence after Roux-en-Y gastric bypass

BackgroundBariatric surgery, such as Roux-en-Y gastric bypass (RYGB) remains the gold standard for treating obesity. Most people regain weight from postsurgery nadir. ObjectivesLiraglutide 3.0 mg is approved for weight management. This study will examine the effects on liraglutide 3.0 mg on weight regain post-RYGB. SettingUniversity Hospital, United States. MethodsA 56-week, double-blind, placebo-controlled study was conducted in 132 subjects, who achieved ≥25% total body weight loss (TBWL) status-post-RYGB and regained ≥10% TBWL after reaching nadir weight (NW). Subjects 18–120 months post-RYGB were randomized to receive liraglutide 3.0 mg/d (n = 89) or placebo (n = 43) with lifestyle counseling regularly for 56 weeks. The co-primary endpoints were the proportion of subjects losing at least 5%, 10%, and 15% TBWL and achieving weight lower than their NW. Results53.4% of the placebo group and 65% of the liraglutide group completed the trial due to Severe acute respiratory syndrome coronavirus 2 pandemic. The change in %TBWL from baseline to 56-weeks was −8.8 (8.5, −29.2 to 9.7) and 1.1 (3.5, −7.9 to 5.99) in the liraglutide and placebo groups, respectively. 76% and 17% of subjects achieved ≥5% TBWL at 56 weeks in the liraglutide and placebo groups, respectively; 51% and 26.0% of the liraglutide group achieved ≥10% and ≥15% TBWL, respectively. None of the placebo group lost ≥10% TBWL. Twenty-one percent of subjects receiving liraglutide surpassed postoperative NW. No subjects on placebo met this goal. Nonserious adverse events occurred in 41.6% of subjects on liraglutide. Serious adverse events (SAE) occurred less often on liraglutide. ConclusionsLiraglutide was significantly more effective than placebo in treating weight regain that occurs post-RYGB without increased SAE.

Weight Regain following Bariatric Surgery and in vitro Fertilization Outcomes

Introduction: The aim of this study was to estimate the time to pregnancy and live birth and evaluate the effect of weight regain in women with a history of bariatric surgery (BS) who underwent in vitro fertilization (IVF) treatments. Methods: This is a retrospective cohort study. All patients with previous BS who underwent IVF treatment in a tertiary university-affiliated hospital between 2013 and 2022 were included. Time to pregnancy and live birth were compared between patients who regained less than or greater than three points of body mass index (BMI) from the nadir weight after BS. Kaplan-Meier curves and log-rank tests were used to compare groups. Results: A total of 78 patients were included in this study. The positive β-hCG, clinical pregnancy, and live birth rates following BS were 89.4%, 78.9%, and 50.8%, respectively. The median time from the beginning of IVF treatments to a positive β-hCG test was 2.97 months (95% CI: 1.04–4.89 months), to a clinical pregnancy was 7.1 months (95% CI: 3.56–10.91), and to a live birth was 20.2 months. Women who maintained their nadir BMI following BS had nearly twice the chance of achieving a clinical pregnancy (HR 1.967, 95% CI: 1.026–3.771, p = 0.042) and were approximately three times more likely to achieve a live birth (2.864, 95% CI: 1.196–6.859, p = 0.018) than those who regained at least three points of BMI. Conclusion: Weight regain after BS is associated with a lower rate of live births and prolonged time to achieve clinical pregnancy and live birth.

Assessment of weight change patterns following Roux en Y gastric bypass, one anastomosis gastric bypass and sleeve gastrectomy using change-point analysis

We aimed to assess the weight loss trend following Roux en Y Gastric Bypass (RYGB), One Anastomosis Gastric Bypass (OAGB), and Sleeve Gastrectomy (SG), utilizing a change-point analysis. A retrospective cohort study was conducted on 8640 patients, from 2009 to 2023. The follow-up period extended to 7 years, with a median follow-up of 3 years (interquartile range: 1.4–5). Following metabolic bariatric surgery, four weight loss phases (three change points) were observed. The primary, secondary, and tertiary phases, transitioned at 12.64–13.73 days, 4.2–4.8 months, and 11.3–13.1 months post-operation, respectively, varying based on the type of procedure. The weight loss rate decreased following each phase and plateaued after the tertiary phase. The nadir weight was achieved 11.3–13.1 months post-procedure. There was no significant difference in the %TWL between males and females, however, males achieved their nadir weight significantly earlier. Half of the maximum %TWL was achieved within the first 5 months, with the greatest reduction rate in the first 2 weeks. Our findings inform healthcare providers of the optimal timing for maximum weight loss following each surgical method and underscore the importance of close patient monitoring in the early postoperative period.

Weight Nadir and Long-Term Weight Outcomes After Laparoscopic Sleeve Gastrectomy in a Diverse Cohort of Adolescents and Young Adults.

Laparoscopic sleeve gastrectomy (LSG) is currently the most common bariatric procedure performed in adolescents and young adults in the United States (USA), but there are limited data available on long-term postoperative weight outcomes in these patients. This single-institution US study follows longitudinal weight data in a diverse group of patients undergoing LSG at age 25years or younger. We retrospectively reviewed records of all patients 25years or younger who underwent LSG at our institution between 2013 and 2020. All weight data documented in the medical record through January 2023 was included. We calculated weight change postoperatively as percent total weight loss (%TWL) relative to preoperative weight. One hundred forty-one patients underwent LSG, at a mean age of 23.1years. Within this cohort, 56.1% identified as non-Hispanic Black or Hispanic, and 39.7% had private health insurance. The mean %TWL at weight nadir was 28.5% at a mean of 1.35years postoperatively. The mean long-term %TWL (in patients with ≥ 4years of follow-up) was 11.8% at a mean of 5.6years postoperatively, with 43 of the 84 patients with long-term weight data (51%) within 10% of their preoperative weight at most recent follow-up. Adolescents and young adults undergoing LSG at our institution had weight nadir comparable to published results during the first 1 to 2years postoperatively, but the majority developed significant weight recurrence over the ensuing years. Our findings highlight the need for adjuvant weight loss strategies to improve the durability of weight outcomes after LSG in this population.

Evaluating a New Digital App-Based Program for Heart Health: Feasibility and Acceptability Pilot Study.

Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)-powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample.

Impact of Recurrent Weight Gain Thresholds on Comorbid Conditions Progression Following Laparoscopic Sleeve Gastrectomy.

Defining recurrent weight gain after metabolic bariatric surgery poses a significant challenge. Our study aimed to standardize recurrent weight gain measurements in patients undergoing laparoscopic sleeve gastrectomy (LSG) and ascertain its association with comorbidity progression. We conducted a retrospective data analysis on 122 patients who underwent LSG, tracking their progress over 2-7years. Data on weight, blood pressure measurements, and laboratory tests were collected, focusing on the postoperative period to identify nadir weight, total weight loss, and recurrent weight gain. Significant weight loss and comorbidity remission were noted, with diabetes, hypertension, and dyslipidemia showing substantial remission rates of 85.71%, 68.24%, and 85.37%, respectively. The median recurrent weight gain was 6.30kg within 12months of the nadir. Progression proportion of diabetes, hypertension, and dyslipidemia were 8.20%, 44.26%, and 40.98%, respectively. Hypertension progression was strongly associated with a recurrent weight gain ≥ 10kg and ≥ 20% of maximum weight loss. Dyslipidemia progression was significantly correlated with recurrent weight gain ≥ 10kg and ≥ 20% of maximum weight loss. Diabetes progression was significantly correlated with recurrent weight gain ≥ 10% of pre-surgery body weight and ≥ 25% of maximum weight loss. A ≥ 10% weight gain of maximum weight loss did not significantly impact the progression of these conditions. Recurrent weight gain ≥ 20% of maximum weight loss can be treated as a specific threshold indicating comorbidity progression post-LSG. Standardizing the measurement of recurrent weight gain can help healthcare providers to implement targeted management strategies to optimize long-term health outcomes.

Contribution of Ultra-Processed Foods to Weight Gain Recurrence 5 Years After Metabolic and Bariatric Surgery.

The aim of this study was to evaluate evolution of ultra-processed food intake and recurrent weight gain in patients who underwent Roux-en-Y gastric bypass. This study is an observational longitudinal study that evaluated patients who underwent metabolic and bariatric surgery at four time points: before surgery and at 3, 12, and 60months after surgery. Anthropometric and dietary intake data were collected through two 24-h dietary recalls. All foods consumed were classified according to degree of processing. Recurrent weight gain was considered the difference between current weight and nadir weight. The sample consisted of 58 patients with a mean age of 38.7 ± 8.9years and 68% female. After 60months, mean excess weight loss and recurrent weight gain were 73.6 ± 27.2% and 22.5 ± 17.4%. Calorie and macronutrient intake decreased significantly between the pre-surgery period, and 3 and 12months post-surgery; however, there was no significant difference after 60months. In relation to food groups or macronutrients, no difference was observed between the pre-surgery period and 60months post-surgery. The contribution of unprocessed or minimally processed foods to calorie intake gradually decreased after 3months post-surgery. The profile of dietary intake after 60months of metabolic and bariatric surgery tends to approach that of the pre-surgery period. The contribution of unprocessed and minimally processed foods to calorie intake decreased after 60months, while ultra-processed food contribution increased.

Weight loss benefits on HDL cholesterol persist even after weight regaining.

Obesity-related comorbidities may relapse in patients with weight regain after bariatric surgery. However, HDL cholesterol (HDLc) levels increase after surgery and seem to remain stable despite a gradual increase in BMI. The aim of this study is to analyze the effects of weight regain after bariatric surgery on HDL cholesterol. This is a retrospective, observational, cohort study in patients who underwent bariatric surgery in the Hospital de la Santa Creu i Sant Pau (Barcelona) between 2007 and 2015. Patients without at least 5 years of follow-up after surgery, under fibrate treatment, and those who required revisional surgery were excluded from the analysis. Data were collected at baseline, 3 and 6 months after surgery, and then annually until 5 years post-surgery. One hundred fifty patients were analyzed. 93.3% of patients reached > 20% of total weight loss after surgery. At 5th year, 37% of patients had regained > 15% of nadir weight, 60% had regained > 10%, and 22% had regained < 5% of nadir weight. No differences were found in HDLc levels between the different groups of weight regain, nor in the % of change in HDLc levels between nadir weight and 5 years, or in the proportion of patients with normal HDLc concentrations either. HDLc remains stable regardless of weight regain after bariatric surgery.

Continued Diabetes Remission Despite Weight Recurrence: Gastric Bypass Long-Term Metabolic Benefit.

Roux-en-Y gastric bypass (RYGB) demonstrates high rates of type 2 diabetes mellitus (T2DM) remission, a phenomenon hypothesized to be mediated mainly by weight loss. Compared with procedures that do not bypass the proximal small intestines, such as sleeve gastrectomy (SG), RYGB exhibits weight loss-independent intestinal mechanisms conducive to T2DM remission. We investigated continued diabetes remission (CDR) rates despite weight recurrence (WR) after RYGB compared with an SG cohort. A retrospective review of patients who underwent successful primary RYGB or SG with a BMI value of 35 kg/m 2 or more and a preoperative diagnosis of T2DM was performed. Patients with less than 5 years of follow-up, absence of WR, or lack of T2DM remission at nadir weight were excluded. After selecting the optimal procedure for glycemic control, rates of CDR were then stratified into WR quartiles and compared. A total of 224 RYGB and 46 SG patients were analyzed. The overall rate of CDR was significantly higher in the RYGB group (75%) compared with the SG group (34.8%; p < 0.001). The odds of T2DM recurrence were 5.5 times higher after SG compared with RYGB. Rates of CDR were stratified into WR quartiles (85.5%, <25%; 81.7%, 25% to 44.9%; 63.2%, 45% to 74.9%; and 60%, >75%). Baseline insulin use, higher preoperative glycosylated hemoglobin, and longer preoperative duration of T2DM were associated with T2DM recurrence, whereas WR was not. T2DM remission rates after RYGB are maintained despite WR, arguing for a concurrent weight loss-independent metabolic benefit likely facilitated by bypassing the proximal small intestine.

Patients' perspectives on weight recurrence after bariatric surgery: a single-center survey.

Weight recurrence (WR) affects nearly 20% of patients after bariatric surgery and may decrease its benefits, affecting patients' quality of life negatively. Patient perspectives on WR are not well known. Assess patient needs, goals, and preferences regarding WR treatment. Single MBSAQIP-accredited academic center, and online recruitment. An 18-item, web-based survey was distributed to adults seeking treatment for WR after a primary bariatric surgery (PBS), in addition to online recruitment, between 2021 and 2023. Survey items included somatometric data, questions about the importance of factors for successful weight loss, procedure decision-making, and treatment expectations. Fifty-six patients with > 10% increase from their nadir weight were included in the study. Patients had initially undergone Roux-en-Y gastric bypass (62.5%), sleeve gastrectomy (28.6%), adjustable gastric banding (3.6%), or other procedures (5.3%). When assessing their satisfaction with PBS, 57.1% were somewhat/extremely satisfied, 33.9% somewhat/extremely dissatisfied, while 8.9% were ambivalent. Patients considered the expected benefits (for example, weight loss) as the most important factor when choosing a treatment option for WR. Patient goals included "feeling good about myself" (96.4% very/extremely important), "being able to resume activities I could not do before" (91% very/extremely important), and "improved quality of life" and "-life expectancy" (> 90% very/extremely important). Finally, RBS, lifestyle modification with peer support, and anti-obesity medication were ranked as first treatment options for WR by 40%, 38.8%, and 29.8% of the respondents, respectively. Patients considered weight loss as the most important factor when choosing treatment modality for WR, with RBS and lifestyle changes being preferred over weight-loss medications. Large prospective randomized trials are needed to counsel this patient population better.

Laparoscopic Toupet-Sleeve gastrectomy in morbid obese patients with preoperative gastro-esophageal reflux: a 4-year follow-up cohort study

Aim To assess the 4-year outcomes after Toupet-Sleeve (TS) gastrectomy in morbid obese patients with concomitant preoperative gastro-esophageal reflux disease (GERD). Material and methods The study group consisted of 19 consecutive patients operated on between August 2017 and February 2019. There were 5 men and 14 women with a mean body mass index (BMI) of 43 ± 5 kg/m2 and a mean age of 42 ± 15 years. A retrospective analysis of database and telephone interview of patients who defaulted clinic follow-up was conducted. The main study end-points were weight loss and success of surgery, defined as no need for conversion and %EWL > 50%. Resolution of GERD was a secondary end-point. Results No patient was lost for follow-up. Nadir weight loss was reached after a follow-up of one year: mean BMI was 32 ± 5 kg/m2, %EWL 61 ± 21% and %TWL 24 ± 7%. Thereafter, we observed a progressive weight regain over time. With a mean follow-up of 51 ± 6 months, mean BMI was 36 ± 8 kg/m2, %EWL 43 ± 35% and %TWL 16 ± 12%. Two patients were converted to another bariatric procedure because of dysphagia and fundus dilatation or because of insufficient weight loss. The overall surgical success rate was 32% (6/19). Resolution of GERD without any PPI treatment was noted in 88% (15/17) of the non-converted patients. Conclusion In our experience, with a 4-year follow-up, TS is associated with a significant risk of conversion, a moderate weight loss and a poor surgical success rate.

What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery.

This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.

Weight Loss Effect of GLP-1 RAs With Endoscopic Bariatric Therapy and Bariatric Surgeries.

Different treatment modalities are available for obesity management, including lifestyle changes, pharmacotherapy, endoscopic interventions, and surgeries. Limited evidence is available on the weight loss effect of combining glucagon-like peptide 1 receptor agonists (GLP-1 RAs) with endoscopic bariatric therapy (EBT) and bariatric surgeries (BS). In this systematic review, we compared the weight loss effect and metabolic changes of combining GLP-1 RAs with EBT and BS. Literature searches were performed in the Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, Embase, PubMed, Google Scholar, and PRISMA databases. Only randomized control trials and retrospective studies were included. A total of 11 studies was included. Nine studies compared BS with and without liraglutide and 2 compared EBT with and without liraglutide. Adding liraglutide to EBT or BS provided significant weight loss when compared with EBT or BS alone. When changes in weight were compared across the studies, EBT with liraglutide showed a weight loss effect comparable to the net weight loss (ie, nadir weight loss after BS-regained weight) achieved following BS alone. This review showcases a promising approach for managing obesity that combines GLP-1 RAs with EBT. This approach is expected to achieve shorter hospital stays, fewer side effects, and longer term weight loss benefits than BS alone. However, additional prospective studies with higher quality, more consistent outcome measures for weight loss and metabolic changes are needed to further evaluate the approach.

FRI075 Single Center Retrospective Matched Cohort Study Of glp1ra-induced Weight Loss In Patients With Post-bariatric Weight Regain Vs Non-surgical Controls

Abstract Disclosure: A. Rivadeneira: None. M. Walker: None. R. Gallop: None. A. Amaro: Advisory Board Member; Self; Novo Nordisk. Research Investigator; Self; Eli Lilly &amp; Company, Novo Nordisk. Background: Obesity prevalence worldwide is increasing. By 2030, almost one-fourth of US population will have severe obesity (BMI &amp;gt;35 mg/kg2). Bariatric surgery (BS) is an effective intervention for weight loss (WL) in patients with severe obesity; weight regain (WR) remains a concern. Over one-third of patients will regain more than 25% of total WL. GLP-1 receptor agonists (GLP1RA) have been effective for WL in patients with obesity. Effectiveness and safety of liraglutide and semaglutide in patients with WR after BS were observed in several retrospective studies. The difference in response to GLP1RA in patients with and without a history of bariatric surgery has not been assessed. Objectives: We aimed to retrospectively compare amount of WL and time to nadir in BMI matched individuals with history of WR following BS and without history of surgery treated with GLP1RA. Methods: Retrospective matched cohort study of the patients referred to Penn Metabolic Medicine (PMM) clinic for non-surgical weight management. We analyzed 63 patients with history of RYGB or VSG seen between 8/2015-8/2021 for WR and who received GLP1RA. BMI matched non-surgical (NS) cohort (N=60) treated with GLP1RA was built from the PMM patients of the same period for comparison. Results: Mean weight on presentation at PMM in surgical group (SG) was 273.1 lbs, (BMI 43.5 kg/m2), and in non-surgical one (NS) 264.9 lbs (BMI 43.3 kg/m2). Nadir weight after initiation of GLP1RA in SG 241.1 lbs and controls 244 lbs, with percentage WL of 11.8% in SG and 7.86% in NS controls (p-value 0.0081). Mean time to nadir weight after initiation of GLP1RA was 17.2 months for SG, and 9.2 months in NS controls (p-value &amp;lt;0.0001). Discussion: When treated with GLP1RA, patients with post-bariatric WR lost on average 12% of their weight and achieved nadir around 17 months. Weight matched NS controls lost less weight and entered a plateau phase faster, suggesting enhanced GLP1RA efficacy after bariatric surgery. Significant WL response to GLP1RA was similar in RYGB and VSG groups, supporting previously demonstrated GLP1RA efficacy for post-bariatric WR. Larger prospective trials are needed for confirmation. Reports suggest both RYGB and VSG increase postprandial GLP-1. Proposed WR mechanisms include hormonal changes, nutritional non-adherence, physical inactivity and maladaptive eating. Hormonal mechanisms include increase in ghrelin, decrease in GLP-1 and peptide YY, post-bariatric hypoglycemia and other pathways. Further studies are needed to elucidate the mechanism of enhanced GLP-1 RA efficacy in patients with WR after BS. The limitations of our study include a retrospective nature, modest sample size and the choice of GLP1RA limited to liraglutide, exenatide and semaglutide and guided by the subjects’ insurance plans. In the future, dual incretins will need to be studied in patients with WR after bariatric surgery. Presentation: Friday, June 16, 2023

Transoral gastric outlet reduction for post-prandial hypoglycemia after Roux-en-Y gastric bypass.

Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and medications; however, some patients develop refractory hypoglycemia that may lead to multiple daily episodes and seizures. While RYGB reversal surgery is an effective treatment, complication rates are high, and patients inevitably experience weight regain. Transoral gastric outlet reduction (TORe) is a minimally invasive treatment that is effective for early and late dumping syndrome. However, prior studies have not distinguished the effectiveness of TORe specifically for patients with post-prandial hypoglycemia. This study aims to describe a single institution's experience of TORe for treating post-prandial hypoglycemia. This is a case series of patients with prior RYGB complicated by post-prandial hypoglycemia who underwent TORe from February 2020 to September 2021. Pre-procedural characteristics and post-procedural outcomes were obtained. Outcomes assessed included post-prandial hypoglycemia episodes, dumping syndrome symptoms, and weight change. A total of 11 patients underwent TORe from 2020 to 2021 for post-prandial hypoglycemia. Three (27%) patients had a history of seizures due to hypoglycemia. All had been advised on dietary changes, and ten patients (91%) were on medications for dumping. All patients reported a reduction in post-prandial hypoglycemic events as well as the majority of dumping syndrome symptoms during an average follow-up time of 409 ± 125days. Ten patients (91%) had experienced weight regain from their post-RYGB nadir weight. For these patients, the average total body weight loss 12months post-TORe was 12.4 ± 12%. There were no complications requiring hospitalization. One patient experienced post-TORe nausea and vomiting requiring dilation of the gastrojejunal anastomosis with resolution in symptoms. TORe is a safe and effective treatment for post-prandial hypoglycemia and weight regain after RYGB in patients with symptoms refractory to medications and dietary changes.

Newborn weight nomograms in selected low and middle-income countries

Growth impairment is common in low- and middle-income countries (LMIC) and may begin during early infancy, increasing morbidity and mortality. To ensure healthy infant growth, healthcare providers in high-income countries (HIC) track newborn weight change using tools developed and validated in HIC. To understand the utility of these tools for LMIC, we conducted a secondary analysis to compare weight trajectories in the first 5 days of life among newborns born in our LMIC cohort to an existing HIC newborn weight tool designed to track early weight change. Between April 2019 and March 2020, a convenience sample of 741 singleton healthy breastfeeding newborns who weighed ≥ 2000 g at birth were enrolled at selected health facilities in Guinea-Bissau, Nepal, Pakistan, and Uganda. Using a standardized protocol, newborn weights were obtained within 6 h of birth and at 1, 2, 3, 4, and 5 days, and nomograms depicting newborn weight change were generated. The trajectories of early newborn weight change in our cohort were largely similar to published norms derived from HIC infants, with the exceptions that initial newborn weight loss in Guinea-Bissau was more pronounced than HIC norms and newborn weight gain following weight nadir was more pronounced in Guinea-Bissau, Pakistan, and Uganda than HIC norms. These data demonstrate that HIC newborn weight change tools may have utility in LMIC settings.

Performance Characteristics of Endoscopic Sleeve Gastroplasty in Patients with Prior Intragastric Balloon: Results of a Propensity Score Matched Study.

The performance characteristics of endoscopic sleeve gastroplasty (ESG) for weight recurrence after intragastric balloon (IGB) are unknown. This is a retrospective propensity score matched study of ESG after IGB (IGB-to-ESG) vs ESG without prior IGB (ESG-only). The primary outcome was total weight loss (TWL) at 12months. Secondary outcomes included TWL at 3 and 6months, 12-month excess weight loss (EWL), procedural characteristics, and safety. Thirty-nine adults underwent ESG from August 2020 to September 2022 after IGB explantation a median of 24months (range 2-56months) prior and a median post-IGB nadir weight increase of 100.0% (range 0 to 3200%). An ESG-only 2:1 age- sex- and BMI- propensity score matched cohort was derived from 649 patients (Pearson's goodness-of-fit: 0.86). TWL for IGB-to-ESG vs. ESG-only was 12.3 ± 13.5% vs. 12.4 ± 3.7% at 3months (p = 0.97), 10.1 ± 7.1% vs. 15.4 ± 4.6% at 6months (p < 0.001), and 8.7 ± 7.7% vs. 17.1 ± 5.7% at 12months (p < 0.001). Twelve-month EWL for IGB-to-ESG vs ESG-only was 27.8 ± 46.9% vs 62.0 ± 21.0% (p < 0.001). There was no difference in mean procedural duration of ESG; however, more sutures were used with IGB-to-ESG vs. ESG-only (7 vs. 6, p < 0.0002). There were no serious adverse events in either cohort. ESG after IGB produces safe, acceptable weight loss but with an attenuated effect compared to ESG alone. Further study is required to understand the factors driving this discrepancy.

Treatment with Antiobesity Drugs in Weight Regain After Bariatric Surgery: a Retrospective Cohort Study.

Bariatric surgery is the most efficient treatment for obesity. However, in some cases, weight regain can occur. Currently, it is unknown the best antiobesity medication (AOM) for such clinical situation. This study aims to evaluate the effect of AOM in patients with weight regain after bariatric surgery. A retrospective cohort study from December 2010 to July 2019 with patients submitted to bariatric surgery that had weight regain and received AOM for at least 2 years. Of 96 patients that had weight regain in the analyzed period and received AOM, 16 were excluded from the analysis due to non-compliance (n = 7), treatment failure (n = 5), intolerable side effects with all available AOM (n = 2), or interaction with other medications (n = 2). Eighty patients were included in the analysis. The mean age was 59.0 ± 10.1 years, 88.8% were female, 91.2% white, and most of them were submitted to gastric bypass (87.6%). The mean preoperative and nadir weight after surgery were 127.9 ± 25.5 kg and 84.7 ± 22.8 kg, respectively. At the initiation of AOM, the mean baseline weight was 99.4 ± 23.1 kg. After 2 years of follow-up, there was significant weight loss in the groups treated with topiramate-alone (- 3.2 kg), topiramate plus sibutramine (- 6.1kg), and orlistat-alone or in combination (- 3.9kg). No statistical difference was observed in the sibutramine-alone group. Topiramate (alone or associated with sibutramine) and orlistat (alone or in combination) promoted significant weight loss after 2 years of use in patients submitted to bariatric surgery with weight regain.

Percentage of maximum weight lost as an optimal parameter of weight regain after bariatric surgery in Chinese patients with diabetes.

The goal of this study was to compare measures of weight regain (WR) and their association with the glucose metabolism deterioration within 3 years following bariatric surgery among Chinese patients with obesity and type 2 diabetes mellitus (T2DM). Among a retrospective cohort of 249 patients with obesity and T2DM who underwent bariatric surgery and were followed up to 3 years, WR was assessed by weight changes, BMI changes, percentage of presurgery weight, percentage of nadir weight, and percentage of maximum weight lost (%MWL). Glucose metabolism deterioration was defined as a change from an absence of antidiabetic medication use to use, or absence of insulin use to use, or an increase in glycated hemoglobin by at least 0.5% to 5.7% or greater. A comparison of C-index of glucose metabolism deterioration indicated %MWL had better discriminatory ability versus weight change, BMI change, percentage of presurgery weight, or percentage of nadir weight (all p < 0.01). The %MWL also had the highest prediction accuracy. The optimal %MWL cutoff point was 20%. Among Chinese patients with obesity and T2DM who underwent bariatric surgery, WR quantified as %MWL predicted 3-year postoperative glucose metabolism deterioration better than the alternatives; 20% MWL was the optimal cutoff point.